Ambulance arrangements

Medical history

A man in his mid fifties developed symptoms in his left arm. It became cold and pale, and he had a tingling sensation.

The symptoms began at about 22.00. According to the patient, a telephone call was made to the out-of-hours GP deputising service at 22.30, asking for a home visit as soon as possible. At 23.42, no doctor having appeared, the deputising service was telephoned on the patient's behalf; this resulted in the deputising doctor attending the patient at 00.35.

She noted cyanosis from the hand up to the elbow. She arranged for the patient to be admitted to the local hospital and for an ambulance to be called. At 00.46, the ambulance service logged an urgent call for an ambulance. It was not a 999 call – but it was categorised as urgent.

The ambulance arrived at the patient's home at 02.05. The patient arrived at the hospital at 02.29. The doctors there diagnosed arterial embolism. Emergency surgery on the arm began at approximately 04.00.

The operation appeared at first to have succeeded. At 06.00, and also at 07.00, the arm was observed to be pink and warm with normal sensation and a palpable radial pulse. Unfortunately, the arm became ischaemic again. A second operation was performed but eventually the arm had to be amputated.

The claim

The patient brought High Court proceedings against the deputising service, the deputising doctor and the ambulance service. He alleged that each had contributed to a delay in getting him to hospital for the emergency treatment he needed – he argued that it ought not to have taken more than four hours to get him to hospital after the first call to the deputising service.

The proceedings were contested by all three defendants. The deputising service denied receiving a telephone call before 23.42. The deputising doctor, represented by The MDU's contended that it he was not in breach of any legal obligations.

The action was also defended on causation – it was argued that the patient would probably have lost his arm even if he had been admitted to hospital within four hours.

Expert opinion

The MDU obtained evidence from a GP expert, who said it was entirely appropriate for the deputising doctor to call the ambulance urgently, as opposed to making a 999 call. Most of the expert evidence addressed the causation issues. A consultant vascular surgeon instructed by the MDU advised that the delay between the onset of symptoms and the operation was not long enough to explain the loss of the arm.

Pointing also to the fact that circulation was restored to the arm following surgery, he advised that the eventual loss of the arm could not be explained other than in terms of a very rare coagulopathy.

Outcome

The case went to a trial. On day one, the action was discontinued against the ambulance service. On day three, the judge gave an informal indication of his evaluation of the factual evidence. As a result of this indication, before any expert evidence had been given, the patient discontinued the proceedings against the deputising service and the deputising doctor.

Although, she was fully supported by the MDU and the action was successfully defended, the deputising doctor had been through the stressful and aggravating experiences of being caught up in legal proceedings and giving evidence at the trial – all arising from the allegation that her urgent request for an ambulance should have been a 999 call.

This page was correct at publication on 01/12/2002. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.